SB0068sam002 96TH GENERAL ASSEMBLY

Sen. Ira I. Silverstein

Filed: 3/5/2009

09600SB0068sam002 LRB096 03606 RPM 23022 a

AMENDMENT TO SENATE BILL 68

AMENDMENT NO. ______. Amend Senate Bill 68 as follows:

on page 1, line 7, by replacing "Coverage for hearing aids for all" with "Audiological services."; and

on page 1, by deleting line 8; and

on page 2, by replacing line 1 through line 26 with the following:

"(b) An individual or group policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 96th General Assembly must provide coverage for audiological services, hearing instruments, and related services for children up to 18 years of age or 23 years of age if enrolled in a post secondary educational program when a hearing care professional prescribes, fits, and dispenses a hearing instrument to augment communication.

(c) An insurer shall provide coverage, subject to all applicable co-payments, co-insurance, deductibles, and out-of-pocket limits for up to $2,000 per hearing impaired ear per coverage period subject to the following restrictions:

(1) a policy or plan may limit the hearing aid benefit coverage period for each hearing-impaired ear to 36 months;

(2) the coverage shall provide for a benefit of $2,000 per hearing-impaired ear per coverage period and guarantors shall be contractually allowed to pay the difference between the benefit amount and the health care professional's usual and customary charge for the device;

(3) the benefit may be used to cover hearing aids, assistive-listening devices, hearing-aid accessories, hearing-aid repairs, earmolds, and remote controls that are prescribed and dispensed by a health care professional;

(4) a policy or plan may provide for up to 4 additional ear molds per year at $50 each for children up to 5 years of age; and

(5) for all insured individuals, any hearing aid may be replaced at any time regardless of the above restrictions if there is a significant change in the insured individual's hearing status; such significant change is defined as a change of 10 decibels HL on the three-frequency pure-tone average (500Hz, 1000 Hz and 2000 Hz) on a valid audiogram provided by a hearing care professional."; and

on page 3, by deleting line 1.